Abstract
Recently a Network of European CNS Transplantation And Restoration (NECTAR) has been founded, aimed at a concerted effort to develop efficient, reliable, safe and ethically acceptable transplantation therapies for neurodegenerative diseases, in particular Parkinson's and Huntington's disease. Owing to the use of human fetal brain tissue in such studies, usually obtained from elective abortions, ethical concerns have been focused on the relationship between abortion and transplantation activities. There is no uniform code on the retrieval and use of human embryonal or fetal material for experimental and clinical research or application in Europe. NECTAR has therefore formulated self-restraining ethical guidelines for its European member groups. These guidelines consist of a series of restrictions intended to prevent the use of grafts from encouraging induced abortions and to maintain high standards of respect for life and human dignity. In order to support applications for human embryonal or fetal neurotransplantation studies of NECTAR member groups to local or national medico-ethical committees, and to stimulate the goal of obtaining European legislation on this issue, the guidelines are here presented. They are followed by extensive explanatory notes. Only in this public manner can the lines of thought behind these NECTAR guidelines be addressed critically by those working in the fields of biomedical ethics and legislation as well by politicians and the general public.
Article PDF
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Avoid common mistakes on your manuscript.
References
Allen GS, Burns RS, Tulipan NB, Parker RA (1989) Adrenal medullary transplantation to the caudate nucleus in Parkinson's disease. Arch Neurol 46:487–491
American Medical Association (1990) Medical applications of fetal tissue transplantation. JAMA 263:565–570
Backlund E-O, Granber P-O, Hamberger B, Sedvall G, Seiger A, Olson L (1985) Transplantation of adrenal medullary tissue to striatum in Parkinsonism. In: Björklund A, Stenevi U (eds) Neural grafting in the mammalian CNS. Fernström Foundation Series. Elsevier, Amsterdam, pp 551–556
Beauchamp TL, Childress JE (1989) Principles of biomedical ethics. Oxford University Press, New York
Björklund A, Stenevi U, Schmidt RH, Dunnett SB, Gage FH (1983) Intracerebral grafting of neuronal cell suspensions. I. Introduction and general methods of preparation. Acta Physiol Scand [Suppl] 522:1–7
BMA guidelines on the use of fetal tissue (1988) Lancet 1:1119
Boer GJ (1991) Notes for the discussion on the ethical issue of clinical neurotransplantation. Report at Founding meeting Network for European CNS Transplantation and Regeneration (NECTAR), Le Vésinet, May 10–11
Bopp J, Burtchaell JT (1988) Report of the Human Fetal Tissue Research Panel, vol 1. US Government Printing Office, Washington, pp 45–71
Brundin P, Nilsson PG, Strecker RE, Lindvall O, Astedt B, Björklund A (1986) Behavioural effects of human fetal dopamine neurons grafted in a rat model of Parkinson's disease. Exp Brain Res 65:235–240
Burnell GM, Norfleet MA (1987) Women's self-reported responses to aborton. J Psychol 121:71–76
Burtchaell JT (1988) Case study: Unversity policy on experimental use of aborted fetal tissue. IRB: A Review of Human Subject Research 10:7–11
Capron AM, Kass LR (1976) A statutory definition of the standards for determining human death. In: Humber JM, Almeder RF (eds) Biomedical ethics and the law. Plenum Press, New York, pp 489–522
Committee of the Netherlands Health Council (1984) Advice on donation and use of fetuses, fetal tissue and other remains of abortion for scientific purposes (Kuitert report). Health Council of The Netherlands, The Hague, no. 19
Committee on Science and Technology (1988) Report on scientific research relating to the human embryo and foetus (Rapporteur: A. Palacios). Parliamentary Assembly of Council of Europe, Strasbourg, Doc 5943
Department of Health and Social Security (1972) The use of fetuses and fetal material for research, report of the advisory group (Peel report) Her Majesty's Stationary Office, London
Dutch Committee on Ethical Aspects of Medical Research (1993) Annual Report 1991 and 1992. Health Council of the Netherlands, The Hague, Publication K93/01
Faria G, Barett E, Goodman LA (1985) Women and abortion: attitudes, social networks, decision-making. Soc Work Health Care 11:85–99
Frankowski SJ, Cole GF (eds) (1987) Abortion and protection of the human fetus. Martinus Nijhoff, Dordrecht
Freed CR, Breeze RE, Rosenberg NL, Schneck SA, Kriek E, Qi J, Lone T, Zhang Y, Snyder JA, Wells TH, Ramig LO, Thompson L, Mazziotta JC, Huang SC, Grafton ST, Brooks D, Sawle G, Schroter G, Ansari AA (1992) Survival of implanted fetal dopamine cells and neurologic improvement 12 to 46 months after transplantation for Parkinson's disease. N Engl J Med 327:1549–1555
Gareth Jones D (1991) Fetal neural transplantation: placing the ethical debate within the context of society's use of human material. Bioethics 5:23–43
Garry DJ, Caplan AL, Vawter DE, Kearney W (1992) Are there really alternatives to the use of fetal tissue from elective abortions in transplantation research? N Engl J Med 327:1592–1595
Gash DM, Collier TJ, Sladek Jr JR (1985) Neural transplantation: a review of recent developments and potential applications to the aged brain. Neurobiol Aging 6:131–150
Goetz CG, Olanow CW, Killer WC, Penn RD, Cahill D, Morantz R, Stebbins G, Tanner CM, Klawans HL, Shannon KM, Comella CL, Witt T, Cox C, Waxman M, Gauger L (1989) Multicenter study of autologous adrenal medullary transplantation to the corpus striatum in patients with advanced Parkinson's disease. N Engl J Med 320:337–341
Greely HT, Hamm T, Johnson R, Price CR, Weingarten R, Raffin T, The Stanford University Medical Center Committee on Ethics (1989) The ethical use of human fetal tissue in medicine. N Engl J Med 320:1093–1096
Hansen JT, Sladek Jr JR (1989) Fetal research. Science 246:775–779
Henderson BTH, Clough CG, Hughes RC, Hitchcock ER, Kenny BG (1991) Implantation of human fetal ventral mesencephalon to the right caudate nucleus in advanced Parkinson's disease. Arch Neurol 48:822–827
Her Majesty's Stationary Office (HMSO) (1989) Review of the guidance on the research and use of fetuses and fetal material (Polkinghorne report), London, Cm 762
Hoffer BJ, Olson L (1991) Ethical issues in brain-cell transplantation. TINS 14:384–388
Isacson O, Hantraye P, Riche D, Schumacher JM, Maziere M (1991) The relationship between symptoms and functional anatomy in the chronic neurodegenerative diseases: from pharmacological to biological therapy in Huntington's disease. In: Lindvall O, Björklund A, Widner H (eds) Intracerebral transplantation in movement disorders. Elsevier, Amsterdam, pp 245–258
Jacobson M (1991) Developmental neurobiology. Plenum Press, New York
Jiang N, Jiang C, Tang Z, Zhang F, Li S, Jiang D (1987) Human foetal brain transplant trials in the treatment of Parkinsonism. Acta Acad Med Shanghai 14:1
King P, Areen J (1988) Legal regulation of fetal tissue transplantation. Clin Res 36:205–208
Kolarik J, Nádvornik P, Tabarka K, Dvorák M (1988) Successful therapeutic transplantation of human embryonic nerve tissue into a schizophrenic brain. Activ Nerv Sup 30:155–157
Koller WC (ed) (1987) Handbook of Parkinson's disease. Dekker, New York
Lawler SD (1981) Conceptation and development of the Fetal Tissue Bank. J Clin Pathol 34:240–248
Legal Affairs Committee (1989) Report on the use of human embryos and foetuses in scientific research (rapporteur: A. Elmquist). Parliamentary Assembly of the Council of Europe, Strasbourg, Doc 5996
Lennette EH, Halonen P, Murphy FA (eds) (1988) Laboratory diagnosis of infectious diseases. Principles and practice, vol II. Springer, New York Berlin Heidelberg
Lindvall O, Brundin P, Widner H, Rehncrona S, Gustavii B, Frackowiak R, Leenders KL, Sawle G, Rothwell JC, Marsden CD, Björklund A (1990) Grafts of fetal dopamine neurons survive and improve motor function on Parkinson's disease. Science 247:574–577
Lindvall O, Widner H, Rehncrona S, Brundin P, Odin P, Gustavii B, Frackowiak R, Leenders KL, Sawle G, Rothwell JC, Björklund A, Marsden CD (1992) Transplantation of fetal dopamine neurons in Parkinson's disease: one-year clinical and neurophysiological observations in two patients with putaminal implants. Ann Neurol 31:155–165
López Lozano JJ, Bravo G, Brera B, Uria J, De Argello J, Salmean J, Insausti J, CPH Neural Transplantation Group (1991) Can an analogy be drawn between the clinical evaluation of Parkinson's patients who undergo autoimplantation of adrenal medulla and those of fetal ventral mesencephalon transplant recipients? Restor Neurol 4:87–98
MacDonald AS (1990) Foetal neuroendocrine tissue transplantation for Parkinson's disease: an institutional review board faces the ethical dilemma. Transplant Proc 22:1030–1032
Madrazo I, Drucker-Colin R, Diaz V, Martinez-Mata J, Torres C, Becerril JJ (1987) Open microsurgical autograft of adrenal medulla to the right caudate nucleus in two patients with intractable Parkinson's disease. N Engl J Med 316:831–834
Madrazo I, Franco-Bourland M, Aguilera M, Ostrosky-Solis F, Cuevas C, Castregon H, Velazquez D, Grijalva E, Guizar-Sahagun G, Magallon E, Madrazo M (1991) Fetal ventral mesencephalon brain homotransplantation in Parkinson's disease: the Mexican experience. In: Lindvall O, Björklund A, Widner H (eds) Intracerebral transplantation in movement disorders, restorative neurology 4. Elsevier, Amsterdam, pp 123–130
Mahowald MB (1988) Placing wedges along a slippery slope: use of fetal neural tissue for transplantation. Clin Res 36:220–222
May WF (1990) Brain death: anencephalics and aborted fetuses. Transplant Proc 22:985–988
McCullagh PM (1987) The foetus as transplant donor. Scientific, social and ethical perspectives. Wiley, Chichester
McLaren A (1989) Report on the use of human foetal embryonic and preembryonic material for diagnostic, therapeutic, scientific, industrial and commercial purposes. Select Committee of Experts on the Use of Human Embryos and Foetuses, Council of Europe, Strasbourg, CAHBI-R-EF: 1
Minister's Deputies of the Committee of Ministers of the Council of Europe (1989) Use of human embryos and foetuses. Council of Europe, Strasbourg, Doc 7244
Molina H, Quiñones R, Alvarez L, Galarraga J, Piedra J, Suárez C, Rachid M, García JC, Perry TL, Santana A, Carmenate H, Macías R, Torres O, Rojas MJ, Córdova F, Muñoz JL (1991) Transplantation of human fetal mesencephalic tissue in caudate nucleus as treatment for Parkinson's disease: the Cuban experience. In: Lindvall O, Björklund A, Widner H (eds) Intracerebral transplantation in movement disorders, restorative neurology 4. Elsevier, Amsterdam, pp 99–110
Mollison PL, Engelfriet CP, Contreras M (1987) Blood transfusion in clinical medicine. Blackwell, Oxford, pp 764–806
National Consultative Ethics Committee for Life Sciences and Health (CNESVS) (1984) Recommendation on the use of embryo tissue as well as tissue of dead foetuses for therapeutic, diagnostic and scientific purposes. Le Comité, Paris
National Consultative Ethics Committee for Life Sciences and Health (CNESVS) (1990) Statement on intracerebral graft of mesencephalic tissue of human embryo origin in patients with Parkinsonism for therapeutic experimentation. Le Comité, Paris
NECTAR (1993) A new program for NECTAR: neural transplants in patients with Huntington's disease. NECTAR Newsl 5
Nolan K (1990) The use of embryo or fetus in transplantation: what there is to lose. Transplant Proc 22:1028–1029
Olson L (1988) Grafting in the mammalian central nervous system: Basic science with clinical promise. Discussion in Neuroscience, vol 5, no. 4, FESN, Geneva
O'Rahilly R, Müller F (1987) Developmental stages in human embryos. Carnegie Institution of Washington, Washington
Parliamentary Assembly of the Council of Europe (1986) On the use of human embryos and foetuses for diagnostic, therapeutic, scientific, industrial and commercial purposes. Council of Europe, Strasbourg, Recommendation 1046
Parliamentary Assembly of the Council of Europe (1989) On the use of human embryos and foetuses for scientific research Council of Europe, Strasbourg, Recommendation 1100
Ralph MR, Foster RG, Davis FC, Menaker M (1990) Transplanted suprachiasmatic nucleus determines circadian period. Science 247:975–978
Robertson JA (1988) Rights, symbolism and public policy in fetal tissue transplants. Hastings Center Report 6
Robertson JA (1990) The ethical acceptability of fetal tissue transplants. Transplant Proc 22:1025–1027
Sladek JR Jr, Shoulson I (1988) Neural transplantation: a call for patience rather than patients. Science 240:1386–1388
Spanish law 42, governing the donation and utilization of human embryos and fetuses, or their cells, tissues or organs, December 1988
Spencer DD, Robbins RJ, Naftolin F, Phil D, Marek KL, Vollmer T, Leranth C, Roth RH, Price LH, Gjedde A, Bunney BS, Sass KJ, Elsworth JD, Kier EL, Makuch R, Hoffer PB, Redmond DE Jr (1992) Unilateral transplantation of human fetal mesencephalic tissue into the caudate nucleus of patients with Parkinson's disease. N Engl J Med 327:1541–1548
US Department of Health and Human Services. Public Health Services and National Institutes of Health (1988) Report of the Human Fetal Tissue Transplantation Research Panel. US Government Printing Office, Washington
Walters L (1988) Ethical issues in fetal research: a look back and a look forward. Clin Res 36:209–214
Warren MA (1975) On the moral and legal status of abortion. In: Wasserstrom R (ed) Today's moral problems. McMillan, New York, pp 120–136
Widner H, Tetrud J, Rehncrona S, Snow B, Brundin P, Gustavii B, Björklund A, Lindvall O, Langston JW (1992) Bilateral fetal mesencephalic grafting in two patients with Parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). N Engl J Med 327:1556–1563
Woods L, Gutierrez Y (1993) Diagnostic pathology of infectious diseases. Lea & Febiger, Philadelphia, pp 573–584
Working Group on Human Embryos and Research (HER) (1992) First report, EC, Directorate General XII Science Research 2nd Development, Brussels
World Medical Association (1990) Statement on fetal tissue transplantation. Bulletin February, pp 8–10
Yezzi R (1980) Medical ethics, thinking about unavoidable questions. Holt, Rinehart and Winston, New York
Author information
Authors and Affiliations
Additional information
NECTAR: M. Peschanski, Secretariat NECTAR, INSERM CJF 91-02 Faculté de Médecine 8 rue du Général Sarrail 94010 Créteil Cedex France
Rights and permissions
About this article
Cite this article
Boer, G.J. Ethical guidelines for the use of human embryonic or fetal tissue for experimental and clinical neurotransplantation and research. J Neurol 242, 1–13 (1994). https://doi.org/10.1007/BF00920568
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00920568